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Clinical evaluation of three posterior composite and two amalgam restorative materials: 3-year results.
The clinical performance of three posterior composites and two amalgams was evaluated over 3 years. Three hundred and nine composites and 200 amalgams were reviewed at the 3-year recall. The following parameters were assessed: fractures, gingival condition, interproximal contacts, marginal adaptation, staining and colour match. Although there was no significant difference in the overall failure rate between the two types of material, there was a significantly higher incidence of fracture in the amalgam restorations. The amalgam failures were exclusively mechanical, whereas those affecting composites also included failures that were more biological in nature. A significantly higher proportion of the Class II composites failed to achieve an adequate approximal contact, but this was not reflected in a more adverse gingival response. Colour match, surface and marginal stain varied significantly within the composite group and appeared to be material-related. Overall, the materials Occlusion and P-30 were considered to be performing adequately. The clinical handling, colour match and radiopacity of Clearfil Posterior were considered to be unsatisfactory.
The caries status of tooth-coloured restorations with marginal stain.
The purpose of this study was to examine histologically teeth containing 27 tooth-coloured restorations with both stained and unstained margins for comparison of their caries status. Histological examination of 56 cavity margins showed that early caries lesions were present adjacent to many stained and unstained margins, but were more likely to be present in the outer enamel and the enamel of the cavity wall where the margin was stained. Thus, the development of staining at the margin of the restoration is likely to indicate caries and the appropriate preventive measures should be instituted.
'Non-setting pastes'.
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Diagnosis of secondary caries: a laboratory study.
Secondary caries is difficult to diagnose accurately. The purpose of this laboratory study was to investigate various non-invasive clinical and radiographic criteria which might predict the presence of carious dentine beneath the margin of the filling. A total of 331 sites, each 3 mm in length on the tooth restoration margin, were selected on 112 extracted and filled teeth. Thirty of these sites showed obvious carious cavities. Ditching was apparent in a further 70 sites, while 231 sites were clinically intact. Staining of the margin of the filling was recorded and radiographs were taken of posterior teeth. Restorations were then removed and the enamel-dentine junction (EDJ) immediately below the sites was examined for its consistency (hard/soft) and colour (stained/stain-free). Results showed that staining around a filling is not a reliable predictor of softening or discolouration of the dentine beneath. A clinical carious cavity and radiographic evidence of demineralisation indicate soft and discoloured dentine and should trigger operative intervention, while ditching alone should not.
Whitening toothpastes: meeting needs or satisfying demands?
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Whitening toothpastes--do we need them?
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Criteria for caries removal at the enamel-dentine junction: a clinical and microbiological study.
In the UK cavity preparation at the enamel-dentine junction (EDJ) is considered complete when all soft and/or stained tissue is removed. The aim of the present work was to link the clinical criteria of dentine consistency and dentine colour with the microbiological status of the tissue. Cavities were prepared in 564 teeth. Under rubber dam, access to the EDJ was gained and the sample sites selected (n = 847). Their consistency was noted as hard or soft and wet or dry when probed. The colour of the site was noted as stain-free or stained. Dentine was sampled using a round bur. After microbiological processing the total anaerobic count and counts of mutans streptococci and lactobacilli were expressed as log10 [CFU per sample]. Soft sites harboured significantly more bacteria than hard sites (P < 0.001). Soft and wet sites harboured significantly more bacteria than soft and dry sites (P < 0.001). Stained and hard sites harboured more bacteria than stain-free and hard sites (P < 0.05) but this difference was not considered to be clinically relevant. The relatively simple clinical criteria used here correlated significantly with the microbial findings. All soft dentine must be removed at the EDJ to ensure minimal infection of the underlying hard dentine. However, it may not be necessary to continue preparation until the EDJ is also stain-free.
The effects of tooth movement upon endodontically treated teeth.
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Spatial chemical analysis of dental stain using wavelength dispersive spectrometry.
Six extracted human teeth with naturally-formed neglected stain were analyzed for chemical constituents using wavelength dispersive spectrometry (WDS), an electron microprobe technique. Spatial distribution, within a few microm resolution, of the compositional elements was obtained by line and map analyses, which provided relative concentrations of the elements in stain-enamel complex. Absolute concentrations at different locations across a specimen were obtained from quantitative analysis. Results showed that these neglected stains were highly calcified and contained a significant amount of organic matter (C, N, O, S), with traces of Fe and Cu. The tooth surface underneath the stain layer could be easily distinguished by the higher Ca and P content, as well as by finite amounts of C and S. Corresponding areas of high concentrations between S and Fe/Cu were observed, which suggested the complex of sulfur and metal ions as possible color-forming species. S was found to diffuse into surface enamel in the range of 10 microm.
Minocycline: stain devil?
Minocycline is the treatment of choice for acne vulgaris, the most common form of inflammatory acne, despite the increase in awareness of rare but significant side-effects. This paper discusses the undesirable side-effect of minocycline staining in permanent teeth.
The effects of Ledermix paste on discolouration of immature teeth.
AIM: The aims of this study were to: (i) investigate the effects of Ledermix paste as an intracanal medicament on discolouration of immature teeth, (ii) examine whether the discolouring effects were related to the method of application, (iii) examine the effects of sunlight upon discolouration of immature teeth and (iv) compare the degree of discolouration between mature and immature teeth. METHODOLOGY: The root canals of 45 immature extracted human teeth were prepared and filled with either Ledermix paste, calcium hydroxide [Ca(OH)2], or saline. In group 1, Ledermix paste was only placed apical to the cemento-enamel junction (CEJ) whilst in groups 2 and 3, the paste filled the entire pulp chamber and the root canals. In group 4, Ca(OH)2 paste and in group 5, saline (control) were allowed to fill the pulp chamber and the root canals. Group 3 teeth were kept in the dark and the other groups were exposed to daylight for 12 weeks. RESULTS: After 12 weeks, sunlight exposure had caused dark grey-brown staining in the Ledermix groups but this did not occur when the teeth were kept in the dark. More severe staining was noted when Ledermix paste filled the pulp chamber than when the paste was restricted to below the CEJ and when teeth were exposed to sunlight. When compared to the results of a similar study using mature teeth, the results were similar but the immature teeth were more severely stained than the mature teeth. The Ca(OH)2 paste caused an increase in lightness and yellowness in immature teeth. CONCLUSION: It was concluded that Ledermix paste may cause discolouration of immature teeth. Such effects can be minimized if placement of the paste is restricted to below the gingival margin. Clinicians should ensure that Ledermix paste is not left on the walls of access cavities, especially in immature teeth.
The effects of Ledermix paste on discolouration of mature teeth.
AIM: The aims of this study were to: (i) investigate the effects of Ledermix paste as an intracanal medicament on discolouration of mature teeth, (ii) examine whether the discolouring effects were related to the method of application, and (iii) examine the effects of sunlight upon discolouration of mature teeth. METHODOLOGY: The root canals of 45 mature extracted human teeth were prepared and filled with either Ledermix paste, calcium hydroxide [Ca(OH)2], or saline. In group 1, Ledermix paste was placed apical to the cemento-enamel junction (CEJ), whilst in groups 2 and 3 the paste filled the entire pulp chamber and root canals. In group 4, a Ca(OH)2 and methyl cellulose paste and, in group 5, saline (control) were allowed to fill the pulp chamber and the root canals. Group 3 teeth were kept in the dark and the other groups were exposed to indirect sunlight for 12 weeks. RESULTS: After 12 weeks, sunlight exposure had caused dark grey-brown staining of the teeth in the Ledermix groups, but this did not occur when the teeth were kept in the dark. More severe staining was noted when Ledermix paste filled the pulp chamber than when the paste was restricted to below the CEJ. CONCLUSIONS: It was concluded that Ledermix paste may cause discolouration of teeth. Such effects can be minimized if placement of the paste is restricted to below the gingival margin. Clinicians should ensure that Ledermix paste is not left on the walls of access cavities.
Review of the current status of tooth whitening with the walking bleach technique.
Internal bleaching procedures such as the walking bleach technique can be used for whitening of discoloured root-filled teeth. The walking bleach technique is performed by application of a paste consisting of sodium perborate-(tetrahydrate) and distilled water (3% H2O2), respectively, in the pulp chamber. Following a critical review of the scientific literature, heating of the mixture is contra-indicated as the risk of external cervical resorption and the formation of chemical radicals is increased by application of heat. An intracoronal dressing using 30% H2O2 should not be used in order to reduce the risk of inducing cervical resorption. This review provides advice based on the current literature and discusses how the walking bleach technique can lead to successful whitening of non-vital root-filled teeth without the risks of side-effects.
UK National Clinical Guidelines in Paediatric Dentistry. Management of the stained fissure in the first permanent molar.
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Enamel hypomineralization of permanent first molars: a morphological study and survey of possible aetiological factors.
OBJECTIVES: The aim of this study was to investigate the morphological appearance of severe hypomineralized enamel of permanent first molars by means of polarized light microscopy, and to estimate the possible time, severity and longevity of the insult. Furthermore, the aim was to survey some commonly implicated aetiological factors in order to gain knowledge about possible pathogenesis of the enamel disturbances which could be compared with future epidemiological studies. SAMPLE AND METHODS: Seventy-three teeth, which had been extracted due to severe hypomineralizations of the enamel, were collected and serially cut longitudinally in a bucco-lingual direction. The sections were examined in polarized light, dry and embedded in water. The children were also examined with respect to the demarcated opacities of other permanent teeth than those that were extracted. The parents were asked about their health during the mother's pregnancy, the time of gestation, birth weight and any complications. They were also asked about the child's health during the first 2 years of its life, the length of time of breast-feeding and also about fluoride supplements. RESULTS: The hypomineralized areas extended cervically from the cusps, comprising about half of the buccal and lingual sides. The cervical borders to normal enamel were well defined and mainly followed the lines of Hunter-Schreger. The hypomineralized zones were covered by thin well-mineralized enamel. The majority of the children had demarcated opacities of all their first molars and also of some permanent incisors. No obvious correlation to the anamnestic data could be found. CONCLUSIONS: The hypomineralized enamel in the investigated teeth demonstrated areas of porosity of varying degrees. The yellow/brown defects were more porous than the white-cream and extended through the whole enamel layer, while the white-cream opacities were situated in the inner parts of the enamel. There had probably been an interacting disturbance of short duration of systemic origin of the activity of the ameloblast during the first 2 years of the child's life, resulting in chronological dispersed hypomineralized demarcated opacities in the developing teeth.
Recognition of veneer restorations by dentists and beautician students.
Three types of veneer restorations (VRs) were evaluated for recognition by two groups of observers to study the aesthetic result. The different types of VRs were: porcelain, direct resin composite and indirect resin composite. One month after insertion of the VRs, colour transparencies were made of smiling patients randomly selected from a group of 112 patients participating in a clinical trial. The slides were evaluated by five dentists who were not familiar with the patients and by 25 beautician students (BS). Dentists were asked to locate the VRs which were present in the patients and to specify the type of VR. BS were only asked to locate the VRs. To trace a possible relationship between the aesthetic result of the treatment and a number of variables, ANOVA was applied to evaluate the variables: 'discolouration of the teeth' before treatment, 'type of VR' and 'number of VRs'. Agreements in judgement were expressed in Cohen-Kappa coefficients. The results showed that the dentists could locate the VRs quite well (Kappa coefficient 0.64 +/- 0.28) but for BS this was lower (Kappa coefficient 0.43 +/- 0.27). The more VRs were made in one patient, the more difficult it was to locate them correctly. The other variables had no significant effect on the recognition of the VRs. It was not possible for the dentist observers to differentiate between the types of VRs.